Pathological gambling in PD

Since the early descriptions of gambling behavior in patients with Parkinson disease (PD),^1,–,3 it has become well-established that pathologic gambling is one of a spectrum of impulse control disorders (ICDs) to which they are prone. Other such behaviors include compulsive sexual behavior, buying, and eating. A cross-sectional study of over 3,000 patients with PD found that the odds of having an ICD were 2- to 3-fold higher in those taking dopamine agonists (DA), though levodopa itself was also associated with ICDs to a lesser extent.⁴ It is also clear from a number of studies that withdrawal of the offending DA typically results in marked improvement in the ICD.⁵ As a result of these observations, it is now routine practice for physicians to counsel patients with PD about the risk of ICDs when prescribing DAs, with a particular emphasis on prompt notification of the treating physician when these problems develop.

As striking and disabling as these behaviors can be, it is also remarkable how uncommon pathological gambling is (5%) in patients with PD taking levodopa, DAs, and other medications.⁴ If …